6/16/08- 6/23/08 Weekly Bird Flu Thread:WHO: Indonesia will report bird flu

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WHO: Indonesia will report bird flu cases

http://www.worldpoultry.net/news/id2205-48509/who_indonesia_will_report_bird_flu_cases.html

A World Health Organisation senior official says the agency has been assured that Indonesia will continue to report human cases of, and deaths from, H5N1 bird flu as they occur.

The WHO sought clarification from Indonesia after Health Minister Siti Fadilah Supari recently stated that the country would only report H5N1 deaths sporadically.

This announcement came with warnings that Indonesia would be in violation of International Health Regulations if this occurred.
An international treaty - Indonesia is a signatory – requires prompt reporting of cases of diseases such as H5N1 that have been designated as global health threats.

"We've received official notice at our WHO office in Jakarta that the minister will continue - as she has been - notifying WHO on confirmed infections under the International Health Regulations," said assistant director general for health security and environment, Dr David Heymann.
 

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Sanofi gives 60 mln H5N1 flu vaccine shots to WHO

http://uk.reuters.com/article/rbssHealthcareNews/idUKL1672359120080616

LONDON, June 16 (Reuters) - Sanofi-Aventis (SASY.PA: Quote, Profile, Research) is to donate 60 million doses of its H5N1 bird flu vaccine to the World Health Organisation, the French drugmaker said on Monday.

The donation over the next three years will help the U.N. health body build a global vaccine stockpile that could be used in poor countries in the event of an outbreak of a human flu pandemic, which many experts fear may be triggered by bird flu.

The United States and some countries have already placed orders for national vaccine stockpiles but there have been concerns that the world's poor could be left without protection.

As a result, the WHO has decided to set up a vaccine stockpile to distribute shots at short notice to poor countries.

Sanofi's move follows a similar agreement by GlaxoSmithKline (GSK.L: Quote, Profile, Research) last year to donate 50 million doses of its bird flu vaccine to the WHO.

While H5N1 remains mainly a virus of birds, scientists say it is the most likely source of the next global flu pandemic in humans, since it may soon mutate into a form that is transmitted easily from person to person.

Sanofi Pasteur -- the vaccines arm of the French group -- is the world's leading provider of conventional seasonal flu vaccine, supplying around 40 percent of the total market, according to the company's own internal estimates.
 

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State, counties form defense against flu pandemic

http://www.pressofatlanticcity.com/114/story/183899.html

Flu season is still months away, but with new cases being reported in Asia, New Jersey is not taking any chances.

Earlier this month, health officials revised the state's plan for dealing with a pandemic like the 1918 Spanish flu that killed more than 4,000 people in this state alone. The revised plan outlines 17 different scenarios of how to fight a dangerous flu virus if it began to spread in the United States.

"It's summer, so the pandemic flu isn't on the top of the list for most people right now," said Tom Slater, spokesman for the state's Department of Health and Senior Services. Regardless, the state wants to develop plans now so it is ready if disaster strikes.

The preparation is definitely warranted, since the H5N1 strain of bird flu was found in poultry in Hong Kong, and the government there announced Wednesday that it plans to kill all poultry in retail markets.

New Jersey officials work with individual counties to develop plans that account for differences in population, traffic, language and other factors.

"Chances are the first case in the United States wouldn't be in Ocean County," said Ed Rumen, risk communicator for the Ocean County Health Department. "We need to take advantage of that lag time."

Population spikes are particularly problematic in an emergency. For example, Ocean County's population during the year is usually about 560,000, but that jumps to about 1.5 million during Independence Day weekend.

Atlantic, Cape May and Cumberland counties also have worked with the state to develop plans. It takes time to develop a vaccine, so preparation is important.

"It's more than likely there won't be any flu vaccine available for the first six months," said Patricia Diamond, director of the health office at Atlantic County's Division of Health. "So we have to educate the community regarding protection."

Education ranges from individuals to large businesses. People who get sick need to wash their hands and stay at home so they don't make their coworkers ill. Local large businesses, such as casinos and hotels, have developed large-scale plans to determine how many employees they need to keep running during an emergency and how much of a stockpile of anti-viral medication they need to distribute.

In addition to the plans, new state guidelines were put in place for Roche, a northern New Jersey-based pharmaceutical company, to work with businesses around the country to make sure that their anti-viral medication, Tamiflu, gets into the hands of everyone who needs it.

Roche said that New Jersey has placed a full order for stockpiles of Tamiflu, and with a shelf life of five years, the drug can last long enough so that stockpiles can continue to accumulate.
 

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China confirms bird flu outbreak in Guangdong Province

http://news.xinhuanet.com/english/2008-06/17/content_8387111.htm

BEIJING, June 17 (Xinhua) -- An outbreak of bird flu in China's southern Guangdong Province is under control, the Ministry of Agriculture said on Tuesday.

The testing of dead ducks at Yashan Village in recent days detected the deadly H5N1 bird flu virus, the ministry said in a brief statement, without giving any dates for when the outbreak began.

A total of 3,873 ducks died and another 17,127 ducks were culled, it said.

Emergency measures have been taken and the epidemic has been brought under control, the ministry said.
 

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CAMBODIA: Taking bird flu lessons to the community

http://www.irinnews.org/report.aspx?ReportID=78777

PHNOM PENH, 17 June 2008 (IRIN) - The government is taking the battle against avian influenza in fowl and humans to the villages, especially in rural areas bordering Thailand and Vietnam, where there have been cases recently. With the UN Food and Agriculture Organization (FAO), it is organising forums, roadshows and workshops to increase awareness among farmers of the potential risks.

"Please don't let anyone else suffer like my daughter: protect yourselves when handling sick chickens, separate them and don't eat chickens that have died," Chhean Chit, father of Cambodia's latest victim of bird flu, told a community forum in Kampong Cham, near his home.

The Chits' 13-year-old daughter died after catching bird flu in April 2007. "My daughter died from contact with an infected chicken - she was not wearing a krama [traditional scarf] and gloves," he told the villagers.

Since April, more than 4,000 people from 25 villages have attended sessions in the provinces bordering Vietnam: Svay Rieng, Takeo, Kampong Cham and Kampot. Village meetings have also been held in some of the border provinces with Thailand.

Seven people, five of them children, have died from bird flu in the past four years, according to the FAO. Cambodia was one of the first countries in the region to experience a serious outbreak of avian influenza, caused by the H5N1 virus. It is now more than a year since the last major outbreak, but concerns persist that farmers, especially in the southern provinces, are still at risk because of the continued confirmed cases of the disease in Vietnam.

"Although there has been no outbreak of avian influenza in Cambodia since last April, the risk of another outbreak is ever-present," Etienne Careme, FAO's emergency programme coordinator in Cambodia, told IRIN. "That is why it's so important to improve the country's capacity to detect outbreaks of the disease – at markets, in large flocks and in backyard farms," he said.

Government ministers and senior provincial officials have understood the need for Cambodia to be more prepared. "Avian influenza is a dangerous disease and if we don't know how to prevent it, it will spread very fast," said Keo Kosal, the deputy governor of Memot District. "The government is very serious about taking action to control the disease."

Awareness drive

But it is clear that government commitment and action alone will not make Cambodia any better prepared without effective community participation, say specialists. "Awareness is the first step to prevention, but only behavioural change can make these plans effective," said Careme.


Photo: FAO
Adding to the risk factor, market workers in Cambodia fail to use protective gloves when handling poultry
In countries where much of the poultry production is in the hands of big commercial companies, regulations can be effectively implemented and policed. But in Cambodia most poultry-rearing happens in backyards. The average flock is fewer than 20 birds.

So a new approach was essential, involving farmers and their families. Information and instructions need to be communicated from the national level, filtered down to the villagers and then filtered up again. In these forums and workshops, villagers learn from each other.

"We've had sick or dead chickens before and just ate them," said 10-year-old Han Sereyroath from Leak Pi village. "But now we know we must bury dead chickens and separate the ill ones. Now I will make sure that I wash my hands before I eat and after touching chickens. I'm also going to give this information to my friends."

Contamination risks

"Live bird markets are a potential source of contamination," said FAO communications specialist Anthony Burnett. "Chickens and ducks are mixed together, market workers slaughter birds without wearing masks or gloves. If there were an outbreak of bird flu there is always a risk it could spread through the market and beyond," he warned. "It is important to work with poultry traders and market workers to help them understand these risks."

Apart from care handling the chickens – wearing protective clothing and basic hygiene – there are several simple rules. Domestic poultry should not mix with wild birds, while ducks and chickens should not be allowed to run together, according to Burnett. "Ducks spread the disease. They don't show recognisable symptoms and they don't die – but they do spread it."

Animal specialists at village level monitor flocks and swabs from sick birds are sent for tests at the provincial laboratory. The FAO has already trained many animal health workers; villagers are encouraged to report any sick birds to them rather than kill the birds or sell the meat.

"I talk to people about how to protect their animals, I go round to homes, and I put up posters. This is a good way of helping others to understand the risk of bird flu and how to protect themselves," said Ma Phirun, 31, one of the specialists in Prea Theat. "People in my village have learned from the posters and tell me about sick chickens, which I then report to the village chief and the district vet."

The Cambodian FAO Avian Influenza project will cost more than US$5 million. The German government ($3,506,892) and USAID ($1,900,000) have provided most of the funds.
 

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Australia approves human bird flu vaccine

http://hosted.ap.org/dynamic/storie...ME&TEMPLATE=DEFAULT&CTIME=2008-06-17-04-49-43

CANBERRA, Australia (AP) -- Australia has approved a locally made bird flu vaccine for humans that researchers hope will provide some protection if the current virus mutates into a new form that triggers a pandemic, the government said Tuesday.

Panvax, produced by Australian-based CSL Ltd., is the latest pre-pandemic vaccine that shows effectiveness in humans against the current H5N1 bird flu virus, Health Minister Nicole Roxon said.

The government contributed more than 7 million Australian dollars (US$6.6 million) to the vaccine's development and Australia's drug regulator, Therapeutic Goods Administration, has registered its use within the country, Roxon said in a statement.

CSL General Manager Mary Sontrop said it was a registration requirement that the vaccine only be supplied in the event of a pandemic declared by the World Health Organization.

She added that providing Australians with vaccine would be her company's first priority. She said the vaccine was not yet licensed for sale outside the country.

Bird flu has killed at least 241 people worldwide and experts fear the virus might mutate into a form that spreads easily among people, potentially sparking a pandemic killing millions worldwide. So far, it remains largely an animal disease, with most human cases occurring after close contact with infected birds.

A few other companies worldwide have received licenses for vaccines, and numerous others are working to develop one. The vaccines are designed to provide protection against the current H5N1 virus, and no one knows for sure how much immunity they would provide if the virus mutates into a different form that spreads easily among people.

Researchers say it would probably take several months after the start of a pandemic to produce a vaccine specifically targeted at the new virus.

Roxon said CSL would ramp up operations after the start of a pandemic to create a vaccine that is effective against the new strain.

CSL's current vaccine is derived from the bird flu virus circulating in Vietnam, said Neil Formica, a vaccine researcher at the company. In trials, it appeared to provide some protection against other versions of the virus, such as the one circulating in Indonesia, he said.

The H5N1 bird flu virus began ravaging Asian poultry stocks in late 2003 and has since spread to Europe, the Middle East and Africa.
 

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Cambodia, FAO vigilant over re-occurrence of bird flu

http://news.xinhuanet.com/english/2008-06/17/content_8386458.htm

PHNOM PENH, June 17 (Xinhua) -- It is important for Cambodia to remain vigilant for possible re-occurrence of avian influenza, as Cambodia shares borders with Vietnam and Thailand where outbreaks of the pathogenic virus continued to occur, said a statement here Tuesday.

The UN Food and Agriculture Organization (FAO) and the Cambodian Ministry of Agriculture, Forestry and Fisheries in their joint statement said that they have been organizing public awareness and education activities to warn Cambodians of the danger avian influenza poses to their poultry and to their health.

Village meetings in Svay Rieng, Takeo, Kampong Cham and Kampot provinces, all bordering Vietnam, have been conducted since April, drawing 4,000 people from 25 villages, it added.

"The ministry and FAO have been working together to provide technical and communication skills training to veterinary officials, village animal health workers and village chiefs, so they will be able to educate the public on actions they can take to prevent avian flu infection," said Kao Phal, Director of the Department of Animal Health and Production at the ministry.

Although Cambodia hasn't had any outbreak since April 2007, it does not mean that the risk of AI is not present anymore, said the statement.

"FAO, with support from the United States Agency for International Development and Germany, will continue to strengthen the government's laboratory capacity to detect bird flu, improve bio-security in the backyard farms and in the markets, as well as in disease surveillance and early response to minimize the risks of avian flu," said Etienne Careme, FAO Emergency Program Coordinator.

In addition, both sides will organize a community forum on avian influenza in Pouk District, Siem Reap province, on June 19.

While not located along the border with Vietnam and Thailand, Siem Reap is among the provinces with the largest poultry population and represents an important trade center for poultry, majority of which is sourced from its villages, said the statement.

Siem Reap experienced an AI outbreak in poultry in two villages in February 2004.

In Cambodia, bird flu has killed seven people, including a 12-year-old girl in Kampong Cham province, the latest case of its kind.
 

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Human flu and Avian flu

http://technocrat.net/d/2008/6/16/43686



CDC researchers recently published a study wherein they created dozens of hybrid viruses that had components of both Avian H5N1 and then human flu viruses like H2N2 and H3N2. They found that several of the creations were highly virulent in animal testing. They say this work is important because it gives them an idea of how any sort of new "wild" hybrid that might be formed would react in the general population. The main issue is whether or not any new wild form will more resemble a strain that most people have built antibodies to ... or not.

"The emergence of an influenza virus that will cause a pandemic is inevitable and therefore preparedness is mandatory. The new pandemic influenza virus is likely to carry a hemagglutinin (HA) gene other than the currently circulating H1 and H3 lineages in order to escape immunity in the human population. However, we cannot predict the mechanism by which the pandemic influenza virus will emerge. One possibility is the transfer of an avian influenza virus from birds to humans, made possible by adaptive mutations,...."

ed.z.: I hope that summary is accurate enough. What I get from it is that a wild new "assortment" is fairly possible and it is also completely unpredictable at this point if it will be highly, mildly, or barely virulent, albeit even the normal wussy human flu is nasty enough all things considered, it is still globally much more lethal on a yearly basis than the sum total of all avian flu fatalities and illnesses so far.
 

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Avian influenza: situation improving but threat remains, UN expert says

http://www.egovmonitor.com/node/19464

Although some countries are facing continuing and significant outbreaks of bird flu, the situation in the rest of the world is improving because of major efforts by governments around the world, the United Nations System Influenza Coordinator said today.

“The situation is really improving… it doesn’t mean that we can say that the situation globally is completely under control – we have the situation in countries where it is still quite entrenched – but it does mean that in the rest of the world there is a great deal of vigilance and action under way,” David Nabarro told reporters in New York.

Dr. Nabarro cited intensive action by the Republic of Korea and the United Kingdom to bring outbreaks under control, as well as financial sector exercises in Australia and the United States to prepare for the impact of potential avian influenza crises. He said that governments had invested massively in improving conditions in which poultry are reared and had increased their focus on the link between animal and human diseases.

There had also been good preparedness work in the travel and tourism sector, as well as progress on updating international health regulations that countries adopt when faced by major health crises.

In addition, Dr. Nabarro welcomed a donation by the pharmaceutical company Sanofi Pasteur of 60 million H5N1 vaccines which he said added to previous donations from GlaxoSmithKline and would help build a global stockpile of vaccines in case of an avian influenza pandemic.

However, the Influenza Coordinator said that the avian influenza virus was still entrenched in five countries – Viet Nam, Bangladesh, India, Egypt and India – and said that outbreaks had been recorded in more than 60 countries by the end of 2007.

“We remain very concerned about Indonesia, where the disease seems to be concentrated among poultry, particularly in Western Java, and we’re also seeing the largest numbers of human cases,” he said.

“We do feel that it’s prudent to continue to be prepared especially as genetic studies of the current bird flu virus show that it is continuously evolving, even though it hasn’t become capable of sustained transmission among humans,” he stressed.
 

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Human bird-flu threat low: Dr York Chow

http://www.news.gov.hk/en/category/healthandcommunity/080618/txt/080618en05005.htm

The risk of human cases of avian influenza in Hong Kong is low thanks to the city's safeguards against the disease. This was the message from Secretary for Food & Health Dr York Chow today in response to the bird flu outbreak at a Guangzhou duck farm.

He said the outbreak involves only one farm which is far from Hong Kong. However, as there is a poultry farm supplying Hong Kong within 13km of the outbreak, exports from the facility were suspended for three weeks yesterday.

Dr Chow said Hong Kong's surveillance system and vigilance greatly hinders the spread of bird flu to humans, so the risk posed to the city by the Guangdong outbreak is low.

Mainland authorities are examining whether there has been any changes to the virus or the ducks' immunity.

"If we do not find any human cases by the end of next Wednesday we will be quite confident there is no human spread," Dr Chow said.

"We are more worried about the subsequent arrangement, whether the existing chickens in the farms and those coming into the market will pose a threat. If that is the case I think we have to have more stringent measures for the markets so we can safeguard poultry workers as well as the public."

He said discussions with the trade about daily cleaning and culling at Hong Kong's markets are ongoing, adding retailers' calls for compensation for ceasing business will be studied.
 

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Guangdong H5N1 Raises Global Expansion Concerns

http://www.recombinomics.com/News/06180801/H5N1_Guangdong_Expansion.html

Recombinomics Commentary 08:59
June 18, 2008

A Hong Kong factory owner based in Yashan said yesterday that most of the duck farmers in the village were from Zhejiang province, rather than locals, and dozens of them bred fish and ducks together.

"I've heard of massive deaths of ducks for several days. Initially, farmers were reluctant to report the case to the local agriculture and fisheries department but, when the virus spread, they could no longer cover it up any more and the officials came," the factory owner said.

The above comments suggest that the recently reported fatal H5N1 infections in ducks in Guangdong province may be more widespread in China. The recent reports on H5N1 positive dead ducks in Jiangmen is not a surprise since H5N1 was recently reported in Hong Kong for the first time in five years. However, the H5N1 in Hong Kong was in asymptomatic chickens, while the H5N1 in Jiangmen, (see satellite map) and additional areas in China is from dead ducks. It is unclear if this difference is linked to changes in the H5N1 or difference in the vaccination status of infected flocks.

Although no recent H5N1 sequences have been released from Hong Kong or southern China, sequences have been published from recent outbreaks in Japan and Russia. The published sequences are almost identical and are said to also be closely related (over 99.7%) to sequences in South Korea.

The HA sequences, which are clade 2.3.2 (Fujian subclade), appear to be closely related to A/common magpie/Hong Kong/5052/2007, based on mapping location in the phylogenetic tree published in the WHO report on H5N1 vaccine targets. The other seven gene segments in the 2008 published sequences are clade 2.3.4 and most closely related to A/China/GD02/2006, which is from a patient in Guangdong province, which provides additional indirect evidence that the H5N1 circulating in Hong Kong is a similar reassortant.

The widespread outbreaks in Hong Kong, followed by the confirmation in Guangdong province adds evidence for a global expansion of the clade 2.3, since it now has been confirmed in long range migratory birds in Japan, which is also the likely source for the H5N1 in Russia and South Korea.

The linkage to Hong Kong provides evidence for transport along the Australia East Asia Flyway and suggests Fujian H5N1 may have already migrated to North America.
 

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Minister: bird flu cases in Indonesia down

http://english.people.com.cn/90001/90782/6433275.html

Indonesian Healthy Minister Siti Fadilah Supari said that in the last six months the number of cases of bird flu on human beings in Indonesia had declined significantly.

In the beginning of the second semester of 2008, the number of the bird flu cases on human beings had dropped, and the number has even reached the lowest compared with those in 2005, 2006 and 2007,the Antara news agency on Thursday quoted the minister as saying in Medan, capital of North Sumatra province.

The main cause of the decline in the bird flu cases on human beings is the fact that people have now become increasingly aware that one should do something as soon as he or she found out that he or she had the symptoms of being affected with this fatal virus Supari said on Wednesday.

At present each regional administration has a guidebook on bird flu for distribution to all layers of the society.

"Thank God, we already have a handbook on bird flu, and we also have the support from some other countries, including Australia, Germany, India, and China," she said.

Bird flu, which started in Indonesia in 2003, has killed 109 people in the country, making it the most affected country by bird flu in the world.
 

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Poultry Deaths on Kamchatka Peninsula Near Alaska

http://www.recombinomics.com/News/06190801/Poultry_Kamchatka.html

Recombinomics Commentary 03:42
June 18, 2008

In the village of Ust-Kozyrevsk Kamchtskogo area on Kamchatka in one of the farmstead of all chickens died suddenly. Veterinarians to begin to worry - not whether it is bird flu. But initial laboratory analysis showed that the birds had died not from the avian influenza virus

Laboratory studies are continuing.

The above translation describes excessive poultry deaths in Kozyrevsk on the Kamchatka peninsula in eastern Russia, approximately 400 miles from Alaska (see satellite map). Although initial tests are negative for bird flu, samples have been sent to Moscow for further analysis.

There have been recent H5N1 outbreaks just to the south of this location in Japan, Russia, and South Korea. All of the earlier outbreaks have been the Fujian strain with a clade 2.3.2 HA sequence, and clade 2.3.4 sequences for the other seven gene segments. The outbreaks have been directly linked to wild birds in Russia and Japan. In Japan, the positives have been whooper swans, which migrate north in the summer, raising the possibility of further movement along the Australia East Asia flyway, which passes over Kamchatka and links to Alaska.

More information of the cause of the dead and dying poultry in Kozyrevsk would be useful.
 

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2 die as Indonesia resumes bird flu reporting

http://www.straitstimes.com/Latest+News/World/STIStory_249801.html

GENEVA - THE Indonesian health ministry has reported two deaths from bird flu in recent weeks, easing concerns about whether Jakarta would share information about the disease, the World Health Organisation said on Thursday.

Indonesia has had more human bird flu infections than any other country, with 110 deaths out of 135 cases, and monitoring the H5N1 virus in the sprawling archipelago is seen as crucial.

The latest infections are the first since Health Minister Siti Fadillah Supari declared two weeks ago that Jakarta had changed its policy on reporting human cases and would only announce the death toll every six months.

The WHO, a United Nations agency, has been seeking clarification on her remarks amid concerns that that the decision could lead to delays in containing outbreaks.

International health regulations (IHR) require the WHO's 193 member states to report human cases of bird flu within 24 hours.

'The minister has told WHO they will not continue to share publicly whenever there is a new case but they will inform the WHO in conformity with IHR,' said Mr David Heymann, WHO assistant director-general for health security and environment.

'We anticipate that promise will be honoured,' he said.

Information sharing
The WHO encourages all governments to share information freely with their populations, but it remains their decision, according to Mr Heymann. Indonesian authorities were still trying to confirm a suspect 111th bird flu death, he added.

The WHO, in a statement reporting information from the health ministry, said that a 16-year-old girl from south Jakarta died on May 14 and a 34-year-old woman from Banten province died on June 3.

Investigation into the girl's death indicate she was exposed to sick and dead poultry, which carried the H5N1 virus, while investigations into the source of the second woman's infection are continuing, according to the WHO.

There have been 385 human bird flu infections, including 243 fatalities, in 15 countries worldwide since 2003, it says.

Indonesia has maintained its decision not to share bird flu samples with WHO laboratories, saying it wants guarantees from richer nations and drugmakers that poor countries would get access to affordable vaccines developed from their samples.

International health experts say it is vital to have access to samples of the constantly-mutating virus, which they fear could change into a form spread more easily among humans and sweep the world in months, killing millions of people.

'There is a strong working relationship between the WHO country office and the government. Even if there is a conflict on issues like virus-sharing, it hasn't eroded the ability to carry out joint investigations,' WHO spokesman John Rainford said in Geneva.

At least 16 companies including GlaxoSmithKline and Sanofi-Aventis are working on vaccines against H5N1.

The next negotiations to hammer out a new virus-sharing agreement among WHO member states are scheduled for November. -- REUTERS
 

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Bird flu mistaken as dengue, typhoid in Indonesia

http://www.straitstimes.com/Latest+News/S-E+Asia/STIStory_249863.html

KUALA LUMPUR - SOME cases of human bird flu in Indonesia have been variously misdiagnosed as dengue fever and typhoid, resulting in the late administration of drugs, a leading doctor in the country said on Friday.

Indonesia has had the highest number of human H5N1 cases in the world and while mortality rates are around 60 per cent in other places, the figure is highest, or at 81 per cent, in Indonesia.

Sardikin Giriputro, director of the Sulianti Saroso Infectious Disease Hospital in Indonesia, told an infectious disease conference in Kuala Lumpur that misdiagnoses and the late administration of drugs were partially responsible for the high mortality rates.

'It (H5N1) is misdiagnosed initially as dengue, bacterial pneumonia, typhoid and upper respiratory tract infection because of similar clinical features (symptoms),' Mr Giriputro said.

Indonesia has had 135 confirmed human H5N1 cases from late 2003 to May 2008 and 110 resulted in deaths. The country reported two more confirmed cases this week, but these were not reflected in Mr Giriputro's figures.

Oseltamivir, otherwise known by its brand Tamiflu, is considered the drug of choice against bird flu and Mr Giriputro said fatalities mounted the later the drug was administered.

The survival rate was very high when Tamiflu was given less than 2 days after the onset of symptoms, but that plunged the later the drug was given.

'It's best if given less than 24 or 36 hours after the onset of symptoms,' he said.

While rapid test kits are now used to diagnose the disease in animals, Mr Giriputro said these tools were much less reliable in people.

'It depends on the viral load (in samples taken from patients),' he said, adding that test results could turn out negative even if the person was infected with H5N1, simply because there was not enough virus in samples taken.

In a bid to reduce the death rate, the Indonesian government has begun distributing Tamiflu to health centres in areas where H5N1 cases have occurred.

'When doctors see influenza-like illnesses and where there is evidence of contact with sick poultry, then they give Tamiflu (without waiting for laboratory results),' Mr Giriputro said.

While H5N1 remains essentially a disease among birds, experts have warned for years now that it could trigger a pandemic, killing millions of people, if it ever manages to become easily transmitted among humans. -- REUTERS
 

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Another H5N1 Case Reporting Failure In Indonesia

http://www.recombinomics.com/News/06190804/H5N1_Indo_54F_Failure.html

Recombinomics Commentary 18:02
June 19, 2008

Results of the Laboratorium Health Hall inspection (BLK) Dinkes West Java on the sample of blood and the suspect's liquid suspect bird flu, late Tini Suhartini (54) from the Babakan Asem Village, Desa Ranjeng, Kecamatan Cisitu, Kabupaten Sumedang, was stated positive H5 bird flu of Avian Influenza-AI).

Was like this it was proposed Dr Hilman Taufik Ws, MKes, Kepala Dinkes Sumedang when being met EndyNews, on Sunday (18-5).

Results of BLK this was indeed positive H5.

The above translation describes lab confirmation of an H5N1 fatality in West Java on May 18. This case was after the cluster in South Jakarta, which was confirmed in today’s WHO update on Indonesia, but before the Tangerang case, which was also confirmed in today’s update. Thus, it appears that this case was not reported to WHO.

The recent denial of a cluster in Subang in March, followed by a delay in reporting the May cluster, and the comments about the benefits of timely reports on these clusters and confirmations, has raised concerns that the delayed reporting will lead to non-reports, which appears to the applicable to the above lab confirmed case.

The reporting failures in Indonesia and the lack of WHO oversight remain causes for concern.
 

JPD

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North Korea denies outbreak of bird flu

http://hosted.ap.org/dynamic/storie...ME&TEMPLATE=DEFAULT&CTIME=2008-06-19-08-21-26

SEOUL, South Korea (AP) -- North Korea strongly denied Thursday that bird flu had recently broken out in the country, contradicting a report from an outside aid group.

The Seoul-based Good Friends organization said last week that the disease had been discovered in the communist nation's northeast on June 3, when several birds were found dead near a military base.

The group also said dozens of magpies were found dead inside a camp for political prisoners in an adjacent province, and a child of one prison official subsequently suffered a high fever and died, although the cause of the deaths was unclear.

The North's official Korean Central News Agency said the country's quarantine authorities found in an investigation that no bird or human had died in the region and that health conditions there were "very safe."

"There is no reason for us to conceal bird flu," KCNA said.

It also said the country was maintaining tight preventive measures against bird flu, including the operation of about 1,600 observatory posts for migratory birds, considered a main transmitter of the disease.

The last confirmed case of bird flu in North Korea was reported in 2005.

Good Friends, a Buddhist-affiliated aid group, sends food and other assistance to North Korea and regularly issues reports on what is happening inside the reclusive nation. The group has previously provided information on North Korea that has proven correct but does not disclose its sources, out of fear they could face retribution.

North Korea is one of the world's most closed nations and it is essentially impossible to independently confirm many developments there.
 

JPD

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Health experts: Global fight against bird flu remains weak,
can worsen global food crisis

http://hosted.ap.org/dynamic/storie...ME&TEMPLATE=DEFAULT&CTIME=2008-06-20-04-44-39

By JULIA ZAPPEI
Associated Press Writer

KUALA LUMPUR, Malaysia (AP) -- The worst of the bird flu threat is over but the fight to eliminate the disease from poultry is weak - a situation that could worsen the global food crisis, health experts warned on Friday.

"The peak is over, but we still are dealing with many outbreaks, small outbreaks," Juan Lubroth, a senior official with the United Nations' Food and Agricultural Organization, said at an international medical conference.

"It's like a boiling pot, and we need to keep the lid on that before it gets worse," Lubroth said at the 13th International Congress on Infectious Diseases, held in Kuala Lumpur, Malaysia.

Bird flu is still active in 10 countries, down from 60 that have been affected since 2003. Hot spots include China, Egypt, Indonesia, Nigeria, Pakistan and Vietnam.

Lubroth, the head of the FAO's Emergency Prevention System, said that "drawbacks and weaknesses" remain in the fight to eliminate the deadly H5N1 strain of the bird flu virus from the poultry sector.

He said death of poultry especially affects the poor, 80 percent of whom own livestock for their livelihood worldwide.

Lubroth said poultry is an important, inexpensive protein source for people who wonder every day, "What are we going to have for dinner tonight, or what will be available for tomorrow?"

He warned that failure to protect their food sources could worsen the global food crisis, caused by rising prices of rice, corn and other staples.

Lubroth said 240 million birds have died or been slaughtered, and millions of people's livelihoods shattered, because of bird flu.

Veterinary services around the world need to be strengthened and more experts trained, while reporting must be more transparent, he said, adding that countries have to use more surveillance and implement policies to deal with the disease. "We fail to see that political commitment," he said.

Besides the threat to the food situation, bird flu could also endanger human lives more directly.

Sporadic suspected human-to-human transmission of H5N1 has been reported in Hong Kong, Vietnam and Indonesia, but none of the cases has been proven. Experts believe the virus remains difficult for humans to catch.

They fear, however, that it could mutate into a form that spreads easily among humans and trigger a pandemic that some say could quickly kill millions of people who would have no immunity to a new flu virus.

"If we want to avert a human pandemic, we must tackle the disease at the source - the source being poultry, the source being poor hygiene, the source being lack of regulatory infrastructures to improve the poultry production sector," Lubroth said.

Still, there was no evidence of sustained human-to-human transmission of H5N1, Nikki Shindo, an infection control specialist at the World Health Organization, told the conference. Bird flu is "not posing a great public health risk" to humans clinically, he said.

Shindo said that 385 people have reportedly contracted the disease since 2003, and that 241 of them have died, about half of them in Indonesia.

Sardikin Giriputro, who has been at he forefront of Indonesia's campaign against bird flu, said that despite all preparations, "no country is prepared enough for the pandemic."
 

JPD

Inactive
Poultry farmers' avian flu warning

http://www.farmersguardian.com/story.asp?sectioncode=1&storycode=19373

News | 20 June, 2008

POULTRY farmers across Britain have been warned to consider the possibility that any disease that fails to respond to treatment might be low pathogenic avian flu.

Defra epidemiologists investigating the source of the avian flu outbreak on an Oxfordshire farm believe a low pathogenic version may be circulating unidentified on British farms.

Clinical evidence from the farm's records suggest that the highly pathogenic (HP) H7N7 virus confirmed on a 25,000-bird laying unit at Shenington, near Banbury, derived from a pre-existing low pathogenic variety.

Increased mortality (2.5 per cent in one shed) and a drop in egg production had been recorded two weeks before birds started dying in large numbers on June 2, leading to the diagnosis of HP H7N7 on June 4.

This has ignited concerns about the possible unidentified presence of low pathogenic avian flu on farms across Britain.

An epidemiology report into the outbreak, published on Tuesday, said clinical signs associated with low pathogenic infection vary greatly from 'none to a high mortality rate'.

“LPAI may be confused with, or complicated by, many diseases with respiratory or enteric signs. Notifiable avian disease including low pathogenic avian flu must be suspected in any poultry disease outbreak that persists despite the application of preventive and therapeutic measures for other diseases.”

It said the inspection of production records may help detect the disease as it effects production parameters and 'strongly advised' good quality record keeping as part of overall flock biosecurity measures.

The report identified two likely hypotheses for the source. One is that wildlife carrying the virus came into contact with the farm's free-range birds.

Wild bird activity in general was low around the infected premises. However, mallard ducks were introduced on to a pond near the one of the farm's four sheds. Further investigations, including tests on the mallards, are in progress.

The other theory being considered is that the source was an 'unidentified' infection in domestic poultry, either on farms close to the infected premises or potential contacts associated with egg collection routes, feed lorries disposal of carcases/manure and personnel.

Initial investigations have uncovered no evidence to support this theory.

Investigations have also ruled out movement of live domestic birds on to the infected premises or imports of live birds, eggs or poultry products into the area.

The Protection Zone and Surveillance Zone remain in place and further surveillance, testing and epidemiological work is on-going.
 

JPD

Inactive
US health official says flu threat high

http://www.bakersfield.com/893/story/478008.html

A top U.S. health official says the threat of a flu pandemic remains high. And while the world has made great strides to prepare, it's not enough.

U.S. Centers for Disease Control and Prevention director Dr. Julie Gerberding says bird flu fatigue among countries and the public is a growing concern.

Scientists have identified the H5N1 bird flu virus as a potential candidate that could mutate into a form that spreads easily among people.

"People have very short attention spans and when something is in the news for a while, it becomes old news and then it's no news," she said at a conference Saturday. "We have to be very strategic to make sure that the leaders and governments fill in for the tendency toward complacency."
 

JPD

Inactive
Fed-up farmers may release chickens in the streets of Hong Kong

http://www.monstersandcritics.com/n..._release_chickens_in_the_streets_of_Hong_Kong

Hong Kong - Chicken farmers may release live poultry into the streets of Hong Kong to protest against anti-bird flu measures that will shut down their businesses, a news report said Saturday.

Farmers have rejected a compensation package offered by the Hong Kong government to buy back chicken farm licenses as part of a raft of measures to reduce the risk of bird flu in the city of 6.9 million.

They walked out of talks with officials Friday, calling the offer 'insulting' and threatening radical action to win more money from the government, the South China Morning Post reported.

Asked what the action would involve, Chicken Breeders Assocation chairman Wong Yee-chuen told the newspaper: '(We may) release our chickens in the streets.'

An outbreak of bird flu in markets in Hong Kong earlier this month led to the slaughter of thousands of chickens and the temporary closure of poultry markets.

Strict measures have since been announced to reduce the risk of a further outbreak including the buying back of chicken farm licences and a ban on markets keeping live poultry overnight.

Hong Kong was the scene of the first modern bird flu outbreak to cross the species barrier in 1997 when the disease infected 18 people, killing six.
 

JPD

Inactive
WHO Commission By Omission On H5N1 H2H In Indonesia

http://www.recombinomics.com/News/06200803/H5N1_Indo_WHO_Omission.html

Recombinomics Commentary 18:06
June 20, 2008

Heymann told Reuters the WHO encourages all governments to provide information freely to their populations, but it is their decision.

Today's WHO statement, citing information from the Indonesian health ministry, said the 16-year-old girl was from South Jakarta and fell ill on May 7; she was hospitalized May 12 and died 2 days later. There was evidence that she had been exposed to sick and dead poultry, the agency said.

A WHO official who requested anonymity told CIDRAP News this week that the agency had been aware of recent H5N1 cases in Indonesia despite the delay in receiving official notification.

Speaking before the latest case confirmations, the official said, "The fact that you don't yet have official notification of any cases doesn't mean there isn't unofficial awareness." He said the two recent cases didn't change WHO experts' assessment of the risk posed by the virus.

If the cases had signaled more of a threat, the information would have been handled differently, he suggested. "If we were dealing with something much more serious, I think there would be a very, very different approach by all involved in getting the information. If you had a cluster of something behaving in an unusual fashion, the pressure to share it would be very high."

The above official and unofficial comments from WHO are curious. Officially, WHO is saying that information on human H5N1 cases in Indonesia should be shared, and WHO routinely publishes situation updates shortly after confirmation of human H5N1 cases. However, unofficially, WHO had knowledge of the above May case long before receiving notification from Indonesia, which was withheld in violation of IHR regulations which require notification of human cases within 24 hours.

The withholding of the information from the situation update is somewhat understandable because the confirmation of the case was not official. However, when WHO did publish the update, the exposure to sick and dead poultry was mentioned, but the exposure to the brother of the confirmed case was not. He had died 10 days prior to the death of the confirmed case, strongly suggesting that he infected the confirmed case. Although the brother was misdiagnosed with typhus, neither the typhus diagnosis nor his death was included in the update. Similarly, the hospitalization of another brother after the death of the confirmed case was also not mentioned. The second brother tested negative for H5N1, but false negatives are common in Indonesia, especially for samples collected after the start of Tamiflu treatment. Such treatment is common for contacts of confirmed cases.

Thus, this cluster had at least three family members, and the death of the first brother strongly suggests that he was H5N1 infected and infected his sister, who may have then infected her other brother, based on disease onset dates. WHO consultants are well aware of the frequent misdiagnosis of H5N1 cases in Indonesia. Such misdiagnosis in patients who were subsequently H5N1 confirmed were tabulated in a New England Journal publication from the beginning of this year.

On condition of anonymity, the WHO official above noted that this cluster was not behaving in an unusual manner. This comment is supported by additional clusters in March, which also included an H5N1 confirmed case linked to a fatally infected family member who was diagnosed as having lung inflammation or dengue fever. However, although such clusters are common in Indonesia, these clusters do not appear in WHO situation updates, or in WHO comments on new cases. As noted above, the WHO update implies the confirmed May case was from poultry exposures, instead of the dead brother who had a disease onset date consistent with human to human (H2H) transmission to his sister.

Although the H2H transmissions in Indonesia are not unusual, most of the general public who accept official denials or WHO omissions at face value would be surprised at the level. Moreover, the reliance on tests of samples collected after Tamiflu treatment for diagnosis leads to significant under-reporting of cases and clusters.

Thus, although WHO officially supports transparency on human H5N1 infections, its situation updates are glaring examples of commission by omission of significant data supporting frequent H2H transmissions in Indonesia.
 

JPD

Inactive
New H5N1 Pandemic Alert System Controls Panic

http://www.recombinomics.com/News/06210802/H5N1_New_Alert_Panic.html

Recombinomics Commentary 21:10
June 21, 2008

WHO’s new system addresses such issues of interpretation with three layers. The first comprises phases 1 to 3 and is defined as “predominantly animal infections; limited transmissibility among people”.
.
Phase 4 would be “sustained human-to-human transmission of animal or hybrid animal-human influenza virus, able to cause sustained community-level outbreaks that have been verified” — this is when health authorities can consider issues such as rapid containment, discussion of phase changes, and switching to a pandemic vaccine.
.
Phases 5 and 6 would comprise the “geographical spread” of flu. There is also a post-pandemic phase.

The above description of the newly proposed pandemic alter levels is curious. The level of human to human (H2H) transmission rose dramatically in 2005 and has been at an increased level ever since, which would require WHO to raise the level to 4 under the old system. However, this would trigger vaccine distribution and implementation of a range of costly pandemic preparedness measures. However, the time between increased H2H transmission and sustained H2H transmission is uncertain. In the past WHO has spent much time and energy denying the increase in H2H, which creates significant credibility issues, since they have been in denial for more than 3 years now.

The denials relied on a rigorous lab confirmation, which was easily avoided by simply not testing index cases, and testing later cases after the start of Tamiflu treatment, which lowered RNA to levels below detection.

These avoidance methods have been on the increase lately, and include the most recent cases in Indonesia.

This approach was evident in one of the largest clusters recorded to date in Indonesia in Garut. Although only three cases were confirmed, each confirmed case was linked to another case that had died shortly before the confirmed case developed symptoms. Moreover, others linked to the confirmed cases developed symptoms and were hospitalized, but a Tamiflu blanket had been applied to the entire village so the subsequent cases recovered and tested negative.

This scenario is still ongoing in Indonesia. Of the five most recent confirmed cases, three are linked to cases which died just prior to disease onset in the confirmed case. In one of the clusters a sibling subsequently developed symptoms and was hospitalized, but recovered and tested negative for H5N1. Thus, for the five most recent official cases there are four associated cases, so of the nine most recent cases, seven were in clusters that involved H2H transmission.

The new system will allow WHO to acknowledge these clusters, which are conspicuously absent from the WHO updates, without an associated increase in alert levels.

The new system will also allow for panic control because when the transmission is sustained, which was the definition of a pandemic under the old system, the sustained transmission will just be at level four.

Levels five and six appear to be for panic control so the public can be reminded that when the pandemic begins there will still be two more levels left, which are linked to the spread of the sustained transmission, which will likely take a few weeks.

Thus, the new system acknowledges that the current level of H5N1 transmission is just one level from a pandemic, but the pandemic level will be called four instead of six, and not appear to be as dire, since the scale will have two additional levels remaining.
 

JPD

Inactive
Chinese deal called off in race to beat bird flu

http://www.bangkokpost.com/220608_News/22Jun2008_news03.php

WHO offers funding and expertise to set up vaccine plant

By Apiradee Treerutkuarkul

Thailand has given up on a deal to transfer technology from Chinese experts and develop a bird flu vaccine production plant to prepare the country in the event of an outbreak of the virus.

Withit Artavatkun, managing director of the Government Pharmaceutical Organisation (GPO), said the agency had decided to hire experts recommended by the World Health Organisation (WHO) instead of working with its Chinese counterpart, the China National Biotech Group, in the construction of a vaccine manufacturing plant here.

''The cell-based technology now used by the group is patented by a Japan-based firm and Thailand cannot reach a deal with its Chinese counterpart and the owner of the technology to manufacture a bird flu vaccine without permission,'' said Dr Withit.

In 2006, the previous government under prime minister Surayud Chulanont decided to start a joint venture with China because the firm was willing to transfer technology to Thailand.

Dr Withit said the agency is now focusing on egg-based technology to develop a bird flu vaccine. Thailand has been granted US$2 million (68 million baht) in funding by the WHO towards setting up a plant at Silpakorn University in Nakhon Pathom.

Results so far from the egg technology are promising, as scientists have developed one dose of bird flu vaccine per 0.6-0.7 chicken egg. Clinical trials of bird flu vaccine in humans are also in progress.

The vaccine factory for industrial-scale manufacturing is under construction in Saraburi's Kaeng Khoi district, but will not be completed for at least another three years.

The 600-million-baht plant is expected to have enough capacity for the entire Thai population if a pandemic occurs.

The Public Health Ministry has estimated that at least 15 million Thais would contract the lethal virus in the event of an outbreak.

Thailand currently administers about 200,000 doses of influenza vaccine a year. The country plans to increase the influenza vaccine stockpile to two million doses in preparation for a possible flu pandemic, which could happen if the H5N1 bird flu virus mixes with the human influenza virus and becomes more virulent.

When the plant is built, more people could be vaccinated against flu, which would also help reduce the possibility of contracting the H5N1 virus, Dr Withit said.

Supamit Choonsuthiwat, a senior medical officer in charge of preparing for a bird flu outbreak, said the ministry would be undertaking a national plan for handling bird flu by next month in order to prepare for any possible outbreak.

Five bird flu outbreaks have occurred since it first surfaced in January 2004, killing more than 60 million fowls and 17 of 25 infected humans. The latest outbreak was reported in Nakhon Sawan and Phichit in late January.

The Livestock Development Department last month declared Thailand free of bird flu after three months passed without any new reports of the virus breaking out.
 

JPD

Inactive
Bird flu prompts cull in Islamabad

http://www.iol.co.za/index.php?set_id=1&click_id=31&art_id=nw20080623090544927C479905

Islamabad - Authorities have culled nearly 2 000 broiler chickens following confirmation of a fresh outbreak of avian influenza in Pakistan's North-West Frontier Province (NWFP), media reports said on Monday.

The culling was carried out in the Swabi district on Sunday after samples taken at a poultry farm tested positive for deadly H5N1 strain of bird flu at a laboratory in the capital Islamabad, English-language The News daily said.

Two-third of the birds at the farm, which had more than 6 000 chickens, died during the last few days while the rest were killed and buried under the supervision of local authorities and UN's World Health Organisation staff.

According to the newspaper, people settled within a three-kilometre radius of the farm had been put under observation to monitor possible bird-to-human transmission.

The News said another farm in the proximity of the infected facility had also been sealed off, and health officials posted at various checkpoints were examining birds being transported out of Swabi district.

Pakistan's poultry population has seen multiple outbreaks of the H5N1 strain since 2006, with almost 80 outbreaks taking place in 2007.

The first human-to-human transmission of bird flu in Pakistan was reported in November 2007 in the NWFP capital Peshawar, where a man passed on the deadly virus to two of his brothers, one of whom died.
 

JPD

Inactive
H5N1 H2H Under-reporting Supports Complacency

http://www.recombinomics.com/News/06220801/H5N1_H2H_Complacency.html

Recombinomics Commentary 16:03
June 22, 2008

U.S. Centers for Disease Control and Prevention director Julie Gerberding said bird-flu fatigue among countries and the public is a growing concern.

Doctor Gerberding told a news conference in Malaysia Saturday that when it comes to news, people have very short attention spans. She said it's up to governments and leaders "to be very strategic" in dealing with problems like flu in order to "fill in for the tendency toward complacency."

The above comments discuss bird flu fatigue, which is created in part by a lack of coverage of human H5N1 clusters and human to human (H2H) transmission. This is due largely to under-reporting by H5N1 hit countries, which is enabled by a lack of WHO oversight and long standing efforts at reducing reports on H2H transmission.

H2H transmission is at the core of the current pandemic alert system. The current phase 3 is linked to no or low H2H transmission. Phase 4 represent increased transmission, while phase 5 is significant transmission, and phase 6 is sustained transmission. There has been increased H2H transmission since 2005, as measured by virtually any parameter (number of H2H clusters, size of H2H clusters, length of H2H transmission chains, or expended global reach of H2H clusters).

However, raising the pandemic level to 4 would initiate a large number of costly pandemic preparedness measures, so the WHO has used a number of approaches to minimize the number of such clusters, which has been actively embraced by a number of affected countries. The activities have been ongoing for several years, but have become the subject of recent media coverage due to Indonesia’s decision to reduce reporting on confirmed or fatal H5N1 cases, at a time when glaring H2H clusters were being under-reported by Indonesia with support in WHO updates which failed to describe the fatalities in relatives with bird flu symptoms.

Although WHO maintains that they have a good relationship with Indonesia and engage in joint investigations, the absence of the fatal cases in the updates raises concerns regarding the relationship and associated transparency in the WHO updates, which are factually correct, but highly misleading. None of most recent five confirmed cases in Indonesia are described as clusters or linked to relatives who died or were hospitalized with bird flu symptoms, which is true for three of the five cases. These relatives are almost certainly H5N1 cases, so the number of recent cases is nine instead of five, and seven of the nine are linked to H2H clusters.

Thus, the number of H2H is difficult to determine from WHO updates or media coverage, and the number of unreported cases and clusters remains unclear, which contributes to bird flu fatigue because much of the important H2H activity remains below the radar.

The new pandemic alert level combines all H2H which is not sustained into the new level 3, reserving level four for sustained H2H, which is the current definition of the final pandemic phase 6.

Thus, WHO should have more latitude in acknowledging the large number of H2H cluster, which will represent a major surprise for most of the public and popular press. Reporting of these clusters will have a significant effect on complacency and lead to the realization that the current phase is very close to the sustained H2H phase, which is another fact that is not well appreciated by the public, media, or relevant agencies.
 

JPD

Inactive
Media Monkey on the Olympics

http://www.guardian.co.uk/media/2008/jun/23/mediamonkey

The BBC has been preparing its legions of staff who will be heading to China for the Olympic games in August with crash courses in the perils of bird flu. Monkey hears all employees have been equipped with emergency supplies of antiviral tablets Tamiflu, which it is recommending they take on the earliest sign of flu-like symptoms. But some hacks are worried they may not be able to tell the difference between the early onset of bird flu and the after-effects of a couple of Tsingtao beers the night before. Back at White City, Monkey hears concern over rising prices at the BBC's food outlets is reaching boiling point. Even worse - look away now, Jon Snow - early morning breakfast is off the menu. "So you can get Tamiflu tablets but you can't get a bowl of cornflakes," said Monkey's simian on the spot. Like the marathon, expect this to run and run.
 
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